Jefferson City Dermatology – Dermatology Physician, NPI 1972668903
Dermatology Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for Jefferson City Dermatology
1241, West Stadium Boulevard, Jefferson City, Cole County, Missouri, 65109, United States
SUITE 1407
JEFFERSON CITY, MO 651096023
Phone: (573) 635-5264
Type: Location
PO BOX 104240
JEFFERSON CITY, MO 651104240
Phone:
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
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Medicare Enrollment & Revalidation
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Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2004-09-01
PECOS data refreshed: 2026-05-27
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Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 65109)
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